While the World Bank states that primary healthcare centres can cater to 90% of all health issues, India remains largely underserved with only 1 primary healthcare centre for every 51,000 Indians. To bridge the healthcare gaps in the country, Nishad Halkarni began his entrepreneurial journey at the age of 20 to design systems and processes that create a seamless experience for all patients.
Nishad co-founded SenseDose Technologies, a social enterprise that aims to help people complete their medical regime for better health outcomes. Nishad’s first intervention was TMEAD – Tuberculosis Monitoring Encouragement Adherence Drive – a device that enables patients diagnosed with tuberculosis to strictly adhere to their medicinal course and further the efforts of the Revised National Tuberculosis Control Programme to eradicate the disease by 2025.
Nishad’s astute understanding of the ecosystem’s needs and his honest approach to problem-solving compelled us to have a tête-à-tête with him on his journey so far and what social entrepreneurs in that healthcare industry should really focus on.
Excerpts from the interview
Q1. What inspired you to work in the healthcare sector?
My dad. He had severe diabetes so I always wanted to do something that would aid a person with diabetes to live a better life. Health supplements were one of the easiest and most effective routes to kickstart with. I started manufacturing a sugar substitute derived from Stevia. While working on Stevia, I realised that there was a need to first address the stigma around taking medication, for anything!
Traditionally, medicines have been non-palatable and people have an inherent aversion towards them. Fortunately, vitamins are water-soluble so I experimented with baking cookies that are rich with Vitamin B12 and Protein. Without any aversion, people can easily munch on this healthy snack. The cookies are FSSAI approved and we currently sell them at exhibitions only.
Q2. How did you move from creating health supplements to giving life to TMEAD?
I had visited Digital Impact Square (DISQ), a TCS Foundation Initiative, to pitch my idea of health supplements and palatable medication. While waiting, I heard a team presenting on the problem of tuberculosis. I was immediately hooked. Mr Sandeep Shinde (Operations Head & Impact Innovation Coach, DISQ) suggested that I join the team, working on the tuberculosis project, to provide nutritional support. However, after I joined, I began addressing the challenge of treatment adherence as it also aligned with my vision to transform the experience of consuming medicines. That’s how TMEAD started.
Q3. How does TMEAD really work?
A single primary healthcare centre has limited resources to cater to multiple patients at a time. This leads to many TB patients waiting in line. A 3-hour wait period results in the direct exposure of the virus to other susceptible patients. A TMEAD machine is given to each patient to take home. It timely dispenses the medication required and patients have to come to the healthcare centre only for refills which are already kept ready for them. This significantly reduces the risk of TB being spread to others as the patient spends minimal time at the centre. Essentially, the platform helps with both, efficiency and adherence of treatment which are the two most crucial factors when it comes to resolving a multi-stakeholder healthcare problem. It also enables last-mile caregivers to effectively retrieve patient information and provide enhanced care to those who need it the most.
Q4. What are the challenges of working in a Tier-II city like Nashik?
I would recommend that anyone who is looking to start a new project should pilot it in Nashik because this place has the perfect balance of different geographical segments- urban, semi-urban, and rural. The ecosystem here is pretty robust – access to Corporates, Government Agencies, Start-up Communities like Digital Impact Square and Nashik Entrepreneurs’ Forum. The positives of working in a Tier-II city like Nashik far outway any challenges that we do face.
Q5. Do you believe that technology is the key to driving systemic change in the healthcare industry?
I would advise all new-age entrepreneurs to avoid fixating on the use of technology to solve a problem when a simple intervention might solve the problem. It is important that you keep your intervention as frugal and robust as possible because it helps you to scale, especially when you are working with the Government. It’s easier to grow your impact from 100 patients to 10,000 this way. That said, if technology has the capacity to substantially improve the existing ecosystem while being frugal and scalable, the same can be perused.
When we first deployed TMEAD, we realised there is a lot of stigma attached to tuberculosis. A female patient told us that she would hide her TMEAD device in her neighbour’s house out of fear that if her in-laws would find out about her condition and disown her.
This encounter led us to go back to the drawing board and think of ways to blend the device into our everyday environment. We thought of tech hacks that would ease the experience. But right now, attaching a clock to the device has ensured it blends into any environment. How simple! This is why it is vital to keep the problem at the heart, and not force-fit technology to solve it.
Q6. There is a perception that working with the Government is tiresome. What has been your experience so far?
I held the same prejudice before I started working with the Government. However, I realised that they, specifically health officers and those working on TB, were extremely dedicated and encouraged youngsters like me to design solutions. Right from helping us pilot our idea to distributing our device to 100+ patients, they have been supportive through the journey. To date, TMEAD was funded by various CSR initiatives. The Government will soon start provided TMEAD free-of-cost to patients. I believe working with the Government is essential to scale.
Q7. What are your plans for scaling TMEAD?
More than 68 per cent of people do not communicate their non-adherence to their doctors or caregivers. This not only results in disease progression but can also lead to the wrong diagnosis. Other diseases such as Diabetes, Hypo/Hyperthyroidism, Hypertension, Epilepsy, Leprosy, AIDS require strict adherence to medication and are probable opportunities to go beyond TB.
Once we collaborate with the Central TB Programme to enhance patient care, we will take the same intervention to help eradiate leprosy and HIV at no-cost for patients.